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What am I missing?


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#1 Bethlehem Babe

Posted 04 May 2017 - 09:35 AM

So my youngest is almost four and has a serious speech delay.
We know that when his grommets were put in at 2.5 years the ent said he was profoundly deaf prior to that and it was reflected in all his behaviors, but his hearing tests only showed a minor to moderate loss because he was reading the prompts. Ent also expects tonsils to be removed as they are very enlarged, but don't appear to be causing dramas now.

Two sets of grommets later, his overall behavior is a changed child. He's so much happier. He's sleeping and eating better and just so happy.

Yet his speech is improved but still at the level of a 2.5 year old.

He's been assessed for autism but doesn't have it (no other indicators other than the delayed speech).

I've not been terribly impressed with the speech therapists I've seen because they have been overtly focused on the possibility of asd for him. My eldest child has asd so I'm pretty familiar with the process and signs and have been watching him for any indicators, but they just aren't there. Even the people assessing my eldest would watch the interactions between the boys and the assessor and youngest and note that the youngest is "normal".

Is it possible that the profound deafness has hindered the way his brain processes language?
Are his enlarged tonsils possibly a problem even if not infected?
Anything else I'm missing?

#2 WreckTangle

Posted 04 May 2017 - 10:36 AM

Ear nose and throat are all connected so yes, tonsils could be an issue, also check adenoids. A good ENT would know what to look for however.

In terms of speech delay, it will take time to play catch up, if you see an improvement then that's a good thing. If you are not happy with the speech therapists, keep trying new ones until you see results.  

Asd also presents itself differently to each child, so it could also be possible something is going on there but it is different to your older child. Go back to a developmental paediatrician with all of the history including your older child's and take it from there.

#3 Pigling_

Posted 04 May 2017 - 10:52 AM

I'm a speech pathologist but I no longer work in paediatrics however, as PP noted definitely keep and eye on the tonsils and adenoids which a good ENT will be doing anyway. Enlarged tonsils and adenoids can prevent drainage of fluid from the middle ear particularly in young children due to their anatomical differences. Given your son has required grommets it would indicate that his hearing loss was secondary to middle ear pathology (fluid build up/glue ear etc).

With regards to his speech and language development it sounds like he has made huge gains since his hearing has improved. That is fabulous! But your ENT suspected that he was likely profoundly deaf prior to his grommets. It's therefore difficult to know how long he really had that hearing loss for and how many speech and language development opportunities he had missed out on. He is essentially making up for lost time and it will take time (and consistent therapy including at home practice) for these skills to reach his age level. Keep working at it. If you aren't happy with your speechie, find a new one but just remember that things won't change overnight.

In terms of asd, in the circumstances of a clearly identified cause for the speech/language delay and absence of other indicators as a professional I wouldn't be particularly concerned about this. Definitely investigate if you are concerned though.

#4 Bethlehem Babe

Posted 04 May 2017 - 11:00 AM

View PostWreckTangle, on 04 May 2017 - 10:36 AM, said:

Asd also presents itself differently to each child, so it could also be possible something is going on there but it is different to your older child. Go back to a developmental paediatrician with all of the history including your older child's and take it from there.

I am aware of the asd presenting differently for each child. The developmental pead we used with the eldest was one who made the comment that he saw no reason for concern after we talked about why his language was delayed.
It's honestly not something I'm worried about because we have discussed it with professionals, but Thought id better mention it.

Sorry if this sounded harsh. My eldest had a long and painful journey to get diagnosis because he didn't meet a lot of the typical indicators, but is very subtle. And once we were able to tease then out, it was pretty much because I had youngest to see the differences. All his teachers etc were shocked when we got the diagnosis until we talked though some of his quirks with them and why they were happening.

One speechie was actually questioning if I understood the signs of asd properly and was really condescending until I went through the details of my eldests lists with her.

Edited by Bethlehem Babe, 04 May 2017 - 11:10 AM.


#5 WreckTangle

Posted 04 May 2017 - 11:06 AM

I think you are on the right track. It will take time to see improvements but the improvements he has had already are a good indication that you are on the right track.

#6 Bethlehem Babe

Posted 04 May 2017 - 11:16 AM

View PostPigling_, on 04 May 2017 - 10:52 AM, said:

I'm a speech pathologist but I no longer work in paediatrics however, as PP noted definitely keep and eye on the tonsils and adenoids which a good ENT will be doing anyway. Enlarged tonsils and adenoids can prevent drainage of fluid from the middle ear particularly in young children due to their anatomical differences. Given your son has required grommets it would indicate that his hearing loss was secondary to middle ear pathology (fluid build up/glue ear etc).

With regards to his speech and language development it sounds like he has made huge gains since his hearing has improved. That is fabulous! But your ENT suspected that he was likely profoundly deaf prior to his grommets. It's therefore difficult to know how long he really had that hearing loss for and how many speech and language development opportunities he had missed out on. He is essentially making up for lost time and it will take time (and consistent therapy including at home practice) for these skills to reach his age level. Keep working at it. If you aren't happy with your speechie, find a new one but just remember that things won't change overnight.

In terms of asd, in the circumstances of a clearly identified cause for the speech/language delay and absence of other indicators as a professional I wouldn't be particularly concerned about this. Definitely investigate if you are concerned though.

Thanks pigling.
I guess I'm just stressing because we are getting close to school starting (18months)

We suspect that he had loss since pretty young- around 4-6 months. He changed from this cruise baby to a baby hat was extremely clingy, no longer slept and was very miserable- more so than a normal baby fussy patch. And the constantly runny eyes. His adenoids were also removed with the first set of grommets.


Ok so on we go. His preschool teacher today said that she is seeing a difference in his language.

#7 sarahec

Posted 04 May 2017 - 02:57 PM

I would find a new speechie! One that listens to you would be great!

Could it be that your son has something like a language disorder (on top on his resolved hearing problems)?

Keep up with the speech therapy! Give it some time and find one you / your son click with.

My son went from severe delay to mild/ borderline in 12 months so your son has time. Edits he starts school and I'm sure you will see big improvements.

#8 Pigling_

Posted 04 May 2017 - 03:40 PM

No problem OP. No doubt you are stressed and it sounds like it has been a long road for you already. It sounds like things are going really well though and no doubt you are doing a fantastic job. 18 months is still a long way off (though I understand how it feels like it is just around the corner!) and given what you have said I'm sure your soon will continue to make significant gains. It's great that others have already started to notice this.

As with any profession there are good clinicians and not so good good clinicians. I would encourage you to look for a speechie who both you and your son feel comfortable with - and who is not condescending. How awful!
Good luck!

#9 blimkybill

Posted 04 May 2017 - 06:58 PM

View Postsarahec, on 04 May 2017 - 02:57 PM, said:

I would find a new speechie! One that listens to you would be great!

Could it be that your son has something like a language disorder (on top on his resolved hearing problems)?

Keep up with the speech therapy! Give it some time and find one you / your son click with.

My son went from severe delay to mild/ borderline in 12 months so your son has time. Edits he starts school and I'm sure you will see big improvements.

View PostBethlehem Babe, on 04 May 2017 - 11:16 AM, said:



Thanks pigling.
I guess I'm just stressing because we are getting close to school starting (18months)

We suspect that he had loss since pretty young- around 4-6 months. He changed from this cruise baby to a baby hat was extremely clingy, no longer slept and was very miserable- more so than a normal baby fussy patch. And the constantly runny eyes. His adenoids were also removed with the first set of grommets.


Ok so on we go. His preschool teacher today said that she is seeing a difference in his language.
If he has been very deaf since 4-6 months, until 2.5, he has missed out on a huge amount of. Normal language development. So now he has had grommets and therapy for less than 18 months, and he has probably caught up at least two years. I would expect plenty more catching up in the next year.

I don't know what approach your SP has used, but if you can work with someone who will teach you different ways of promoting his language through everyday activities and just changing the way you speak to him, that can really help. Also if he goes to childcare make sure the staff know how to speak to him in ways that maximise language develop,net. It's not about homework as such for this type of problem, it's about changing the way you talk throughout the whole day.
Hanen programs are excellent for this, if you can access that.

#10 Paddlepop

Posted 04 May 2017 - 07:25 PM

BB: Please don't stress that you're missing something about DS2. He lost two years of speech development at such a crucial stage of life, and he's catching up on that now. It's going to take a while for him to catch up. He's making progress. Remember that. He's progressing in the right direction.

I assume he'll be going to DS1's school? They seem to be pretty supportive for DS1, so they probably will be for DS2 as well. Does the school have a speech therapist? Hopefully he'll be able to receive speech therapy via school to help support his speech development. My DD sees our school speechie, and one of her teacher aides has been trained to deliver a personalised one on one speech therapy programme at school. It might be worth talking to the school now about what sort of services they might be able to offer him, to help ease your worries. Depending on his level of speech and language, they should be able to alter things like doing show and tell or speeches to be appropriate to his ability.

#11 Bethlehem Babe

Posted 18 June 2017 - 11:50 PM

Short update. Child ruptured his ear drum last week. Full of pressure and glue. Thick sticky smelly glue.

No other signs. He hasn't had a cold, wasn't snotty. Was eating, happy, sleeping. Chatting. So he was effectively deaf until rupture. Since rupture, a clearer and chattier child. Three to four word sentences "oh! Where'd she go?" "Ahh there she is!"
Appointment with audiologist and ent again this week.

Last check up was in March and was all clear, although grommets extruded.

So essentially I was missing that he was possibly near deaf again.

Edited by Bethlehem Babe, 19 June 2017 - 07:13 AM.





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